U.S. patent application number 10/566204 was filed with the patent office on 2008-02-28 for internal treatment apparatus for a patient and an internal treatment system for a patient.
Invention is credited to Kunitoshi Ikeda, Tadao Kakizoe, Toshiaki Kobayashi, Kenichi Ohara, Hiroshi Sano, Akira Sugiyama.
Application Number | 20080051629 10/566204 |
Document ID | / |
Family ID | 34106921 |
Filed Date | 2008-02-28 |
United States Patent
Application |
20080051629 |
Kind Code |
A1 |
Sugiyama; Akira ; et
al. |
February 28, 2008 |
Internal Treatment Apparatus for a Patient and an Internal
Treatment System for a Patient
Abstract
An internal treatment apparatus for a patient having a flexible
tubular body to be introduced into a patient includes a center
opening for inserting therethrough an endoscope for observing a
target site, the center opening being circular in cross section and
disposed at a center of an end face of the flexible tubular body;
and a plurality of circumferential apertures through which surgical
instruments are inserted for performing a surgical procedure on the
target site, the plurality of circumferential apertures being
provided in the flexible tubular body at equi-angular intervals
around the center opening.
Inventors: |
Sugiyama; Akira; (Kanagawa,
JP) ; Ohara; Kenichi; (Gunma, JP) ; Sano;
Hiroshi; (Chiba, JP) ; Ikeda; Kunitoshi;
(Tokyo, JP) ; Kakizoe; Tadao; (Tokyo, JP) ;
Kobayashi; Toshiaki; (Tokyo, JP) |
Correspondence
Address: |
GREENBLUM & BERNSTEIN, P.L.C.
1950 ROLAND CLARKE PLACE
RESTON
VA
20191
US
|
Family ID: |
34106921 |
Appl. No.: |
10/566204 |
Filed: |
July 16, 2004 |
PCT Filed: |
July 16, 2004 |
PCT NO: |
PCT/JP04/10539 |
371 Date: |
January 27, 2006 |
Current U.S.
Class: |
600/114 |
Current CPC
Class: |
A61B 1/018 20130101;
A61B 5/0084 20130101; A61B 1/00193 20130101; A61B 5/0071 20130101;
A61B 1/015 20130101; A61B 8/12 20130101; A61B 1/043 20130101; A61B
1/31 20130101; A61B 17/29 20130101; A61B 2017/2906 20130101; A61B
1/0638 20130101; A61B 1/12 20130101; A61B 5/0068 20130101; A61B
90/37 20160201; A61B 17/3421 20130101; A61B 1/0125 20130101; A61B
5/0066 20130101; A61B 2017/3445 20130101; A61B 8/4416 20130101 |
Class at
Publication: |
600/114 |
International
Class: |
A61B 1/01 20060101
A61B001/01 |
Foreign Application Data
Date |
Code |
Application Number |
Jul 29, 2003 |
JP |
2003-281850 |
Jan 20, 2004 |
JP |
2004-011954 |
Claims
1. An internal treatment apparatus for a patient having a flexible
tubular body to be introduced into a patient, said flexible tubular
body comprising: a center opening for inserting therethrough an
endoscope for observing a target site, said center opening being
circular in cross section and disposed at a center of an end face
of said flexible tubular body; and a plurality of circumferential
apertures through which surgical instruments are inserted for
performing a surgical procedure on said target site, said plurality
of circumferential apertures being provided in said flexible
tubular body at equi-angular intervals around said center
opening.
2. An internal treatment system for a patient comprising: a
flexible tubular body, to be introduced into a patient, said
flexible tubular body including a center opening for inserting
therethrough an endoscope for observing a target site, said center
opening being circular in cross section and disposed at a center of
an end face of said flexible tubular body, and a plurality of
circumferential apertures through which surgical instruments are
inserted for performing a surgical procedure on said target site,
said plurality of circumferential apertures being provided in said
flexible tubular body at equi-angular intervals around said center
opening; a body manipulating device for manipulating said flexible
tubular body from outside said patient; an endoscope manipulating
device for manipulating said endoscope from outside said patient;
and a surgical instrument manipulating device for manipulating said
surgical instruments from outside said patient.
3. An internal treatment apparatus for a patient comprising a
flexible tubular body to be introduced into a patient, said
flexible tubular body comprising: a center opening for inserting
therethrough an endoscope for observing a target site, said center
opening extending through said flexible tubular body from a center
of a distal end face of said flexible tubular body, said distal end
face facing said target site, and a plurality of circumferential
apertures through which surgical instruments are inserted for
performing a surgical procedure on said target site, said plurality
of circumferential apertures being provided to extend through said
flexible tubular body from a side face of said flexible tubular
body.
4. An internal treatment system for a patient comprising: a
flexible tubular body to be introduced into a patient, said
flexible tubular body including a center opening for inserting
therethrough an endoscope for observing a target site, said center
opening being circular in cross section and extending through said
flexible tubular body from a center of a distal end face of said
flexible tubular body, said distal end face facing said target
site, and a plurality of circumferential apertures through which
surgical instruments are inserted for performing a surgical
procedure on said target site, said plurality of circumferential
apertures being provided to extend through said flexible tubular
body from a side face of said flexible tubular body; a body
manipulating device for manipulating said flexible tubular body
from outside said patient; an endoscope manipulating device for
manipulating said endoscope from outside said patient; and a
surgical instrument manipulating device for manipulating said
surgical instruments from outside said patient.
5. An internal treatment apparatus for a patient comprising a
flexible tubular body to be introduced into a patient, said
flexible tubular body comprising: a center opening for inserting
therethrough an endoscope for observing a target site, said center
opening extending through said flexible tubular body from a center
of a distal end face of said flexible tubular body, said distal end
face facing said target site, and a plurality of circumferential
apertures through which surgical instruments are inserted for
performing a surgical procedure on said target site, each of said
plurality of circumferential apertures being provided to extend
through said flexible tubular body in an area including said distal
end face and a side face of said flexible tubular body.
6. An internal treatment system for a patient comprising: a
flexible tubular body to be introduced into a patient, said
flexible tubular body including a center opening for inserting
therethrough an endoscope for observing a target site, said center
opening being circular in cross section and extending through said
flexible tubular body from a center of a distal end face of said
flexible tubular body, said distal end face facing said target
site, and a plurality of circumferential apertures through which
surgical instruments are inserted for performing a surgical
procedure on said target site, each of said plurality of
circumferential apertures being provided to extend through said
flexible tubular body in an area including said distal end face and
a side face of said flexible tubular body; a body manipulating
device for manipulating said flexible tubular body from outside
said patient; an endoscope manipulating device for manipulating
said endoscope from outside said patient; and a surgical instrument
manipulating device for manipulating said surgical instruments from
outside said patient.
7. The internal treatment apparatus for a patient according to
claim 1, wherein said endoscope is a stereoscopic endoscope
allowing an operator to stereoscopically observe the target
site.
8. The internal treatment apparatus for a patient according to
claim 1, wherein said surgical instrument comprises a monitor
device allowing an operator to observe a vicinity of a distal end
of said surgical instrument.
9. The internal treatment apparatus for a patient according to
claim 8, wherein said surgical instrument comprises an illumination
device which allows an operator to illuminate a vicinity of said
distal end of said surgical instrument with light.
10. The internal treatment apparatus for a patient according to
claim 9, wherein said surgical instrument comprises at least one of
an air feed device and a water feed device which allows an operator
to clean a distal end of said monitor device.
11. The internal treatment system for a patient according to claim
2, further comprising an image displaying device for displaying an
image formed by said endoscope.
12. The internal treatment apparatus for a patient according to
claim 1, wherein said flexible tubular body comprises a resiliently
deflectable portion.
13. The internal treatment apparatus for a patient according to
claim 1, wherein said surgical instrument comprises a resiliently
deflectable portion.
14. The internal treatment apparatus for a patient according to
claim 3, wherein said flexible tubular body comprises grooves
provided between each adjacent said circumferential apertures.
15. The internal treatment apparatus for a patient according to
claim 3, wherein a projection angle of said surgical instruments
from said flexible tubular body is smaller than a half angle of a
field-of-view of said endoscope.
16. The internal treatment apparatus for a patient according to
claim 3, wherein said endoscope comprises an illumination device
which emits white light, and said surgical instruments each
comprises an illumination device which emits colored light.
17. The internal treatment apparatus for a patient according to
claim 16, wherein each said illumination device of said surgical
instruments continuously emits colored light.
18. The internal treatment apparatus for a patient according to
claim 16, wherein each said illumination device of said surgical
instruments emits colored light intermittedly.
19. The internal treatment apparatus for a patient according to
claim 3, wherein said endoscope comprises an illumination device,
and said surgical instruments each comprises an illumination device
which emits light having light intensity different from that of
light emitted from said illumination device of said endoscope.
20. The internal treatment system for a patient according to claim
2, wherein said endoscope is a stereoscopic endoscope allowing an
operator to stereoscopically observe the target site.
21. The internal treatment system for a patient according to claim
2, wherein said surgical instrument comprises a monitor device
which allows an operator to observe a vicinity of a distal end of
said surgical instrument.
22. The internal treatment system for a patient according to claim
21, wherein said surgical instrument comprises an illumination
device which allows an operator to illuminate a vicinity of said
distal end of said surgical instrument with light.
23. The internal treatment system for a patient according to claim
22, wherein said surgical instrument comprises at least one of an
air feed device and a water feed device which allows an operator to
clean a distal end of said monitor means.
24. The internal treatment system for a patient according to claim
2, further comprising an image displaying device for displaying an
image provided by said endoscope.
25. The internal treatment system for a patient according to claim
2, wherein said flexible tubular body comprises a resiliently
deflectable portion.
26. The internal treatment system for a patient according to claim
2, wherein said surgical instrument comprises a resiliently
deflectable portion.
27. The internal treatment system for a patient according to claim
4, wherein said flexible tubular body comprises grooves provided
between each adjacent said circumferential apertures.
28. The internal treatment apparatus for a patient according to
claim 4, wherein a projection angle of said surgical instruments
from said flexible tubular body is smaller than a half angle of a
field-of-view of said endoscope.
29. The internal treatment apparatus for a patient according to
claim 4, wherein said endoscope comprises an illumination device
which emits white light, and said surgical instruments each
comprises an illumination device which emits colored light.
30. The internal treatment apparatus for a patient according to
claim 29, wherein each said illumination device of said surgical
instruments continuously emits colored light.
31. The internal treatment apparatus for a patient according to
claim 29, wherein each said illumination device of said surgical
instruments emits colored light intermittedly.
32. The internal treatment apparatus for a patient according to
claim 4, wherein said endoscope comprises an illumination device,
and said surgical instruments each comprises an illumination device
which emits light having light intensity different from that of
light emitted from said illumination device of said endoscope.
Description
BACKGROUND OF THE INVENTION
[0001] The present invention relates to an internal treatment
apparatus for a patient and an internal treatment system for a
patient which are designed for severing, or the like, a target site
inside a patient (subject), and more particularly, to an apparatus
and a system for performing medical treatment on a site of lesion
inside a patient.
DESCRIPTION OF THE RELATED ART
[0002] In a conventional surgical procedure performed on a site of
lesion inside a patient, operators would directly manipulate a
surgical instrument that had been introduced into the patient
through an incised portion. On the other hand, recent years have
also seen a newly developed method for the operator to remotely
manipulate a surgical instrument introduced into a patient through
an incised portion without directly touching the surgical
instrument (For example, see Japanese Patent Laid-Open Publication
No. 2001-104333).
[0003] The aforementioned surgical procedure performed on a site of
lesion inside a patient often requires a plurality of surgical
instruments to be introduced through an incised portion at the same
time, and in such a case, the length of the incised portion has to
be increased in accordance with an increase in the number of
surgical instruments to be introduced at the same time.
[0004] To perform a surgical procedure on a site of lesion located
deep inside a patient away from the body surface, it is also
necessary to increase the length of an incised portion because an
insufficient length of the incised portion makes it difficult to
ensure a sufficient field of view.
[0005] Furthermore, during the aforementioned surgical procedure
performed on a site of lesion inside a patient, the surgical
instrument may obstruct the view window provided by an endoscope to
restrict the field of view, thereby possibly making it difficult to
view the site of lesion and the surrounding area thereof.
[0006] Furthermore, a plurality of surgical instruments being
introduced into a patient would readily interfere with each other
or with the endoscope, whereby the surgical instruments and the
endoscope could not access the site of lesion in some cases.
SUMMARY OF THE INVENTION
[0007] According to an aspect of the present invention, an internal
treatment apparatus for a patient having a flexible tubular body to
be introduced into a patient is provided, the flexible tubular body
including a center opening for inserting therethrough an endoscope
for observing a target site, the center opening being circular in
cross section and disposed at a center of an end face of the
flexible tubular body; and a plurality of circumferential apertures
through which surgical instruments are inserted for performing a
surgical procedure on the target site, the plurality of
circumferential apertures being provided in the flexible tubular
body at equi-angular intervals around the center opening.
[0008] In another embodiment, an internal treatment system for a
patient including a flexible tubular body, to be introduced into a
patient, the flexible tubular body including a center opening for
inserting therethrough an endoscope for observing a target site,
the center opening being circular in cross section and disposed at
a center of an end face of the flexible tubular body, and a
plurality of circumferential apertures through which surgical
instruments are inserted for performing a surgical procedure on the
target site, the plurality of circumferential apertures being
provided in the flexible tubular body at equi-angular intervals
around the center opening; a body manipulating device for
manipulating the flexible tubular body from outside the patient; an
endoscope manipulating device for manipulating the endoscope from
outside the patient; and a surgical instrument manipulating device
for manipulating the surgical instruments from outside the
patient.
[0009] In another embodiment, an internal treatment apparatus for a
patient including a flexible tubular body to be introduced into a
patient, the flexible tubular body including a center opening for
inserting therethrough an endoscope for observing a target site,
the center opening extending through the flexible tubular body from
a center of a distal end face of the flexible tubular body, the
distal end face facing the target site, and a plurality of
circumferential apertures through which surgical instruments are
inserted for performing a surgical procedure on the target site,
the plurality of circumferential apertures being provided to extend
through the flexible tubular body from a side face of the flexible
tubular body.
[0010] In another embodiment, an internal treatment system for a
patient including a flexible tubular body to be introduced into a
patient, the flexible tubular body including a center opening for
inserting therethrough an endoscope for observing a target site,
the center opening being circular in cross section and extending
through the flexible tubular body from a center of a distal end
face of the flexible tubular body, the distal end face facing the
target site, and a plurality of circumferential apertures through
which surgical instruments are inserted for performing a surgical
procedure on the target site, the plurality of circumferential
apertures being provided to extend through the flexible tubular
body from a side face of the flexible tubular body; a body
manipulating device for manipulating the flexible tubular body from
outside the patient; an endoscope manipulating device for
manipulating the endoscope from outside the patient; and a surgical
instrument manipulating device for manipulating the surgical
instruments from outside the patient.
[0011] In another embodiment, an internal treatment apparatus for a
patient including a flexible tubular body to be introduced into a
patient, the flexible tubular body including a center opening for
inserting therethrough an endoscope for observing a target site,
the center opening extending through the flexible tubular body from
a center of a distal end face of the flexible tubular body, the
distal end face facing the target site, and a plurality of
circumferential apertures through which surgical instruments are
inserted for performing a surgical procedure on the target site,
each of the plurality of circumferential apertures being provided
to extend through the flexible tubular body in an area including
the distal end face and a side face of the flexible tubular
body.
[0012] In another embodiment, an internal treatment system for a
patient including a flexible tubular body to be introduced into a
patient, the flexible tubular body including a center opening for
inserting therethrough an endoscope for observing a target site,
the center opening being circular in cross section and extending
through the flexible tubular body from a center of a distal end
face of the flexible tubular body, the distal end face facing the
target site, and a plurality of circumferential apertures through
which surgical instruments are inserted for performing a surgical
procedure on the target site, each of the plurality of
circumferential apertures being provided to extend through the
flexible tubular body in an area including the distal end face and
a side face of the flexible tubular body; a body manipulating
device for manipulating the flexible tubular body from outside the
patient; an endoscope manipulating device for manipulating the
endoscope from outside the patient; and a surgical instrument
manipulating device for manipulating the surgical instruments from
outside the patient.
[0013] It is desirable for the endoscope to be a stereoscopic
endoscope allowing an operator to stereoscopically observe the
target site.
[0014] The surgical instrument can include a monitor device
allowing an operator to observe a vicinity of a distal end of the
surgical instrument.
[0015] The surgical instrument can include an illumination device
which allows an operator to illuminate a vicinity of the distal end
of the surgical instrument with light.
[0016] The surgical instrument can include at least one of an air
feed device and a water feed device which allows an operator to
clean a distal end of the illumination device.
[0017] It is desirable for the internal treatment system to further
include an image displaying device for displaying an image formed
by the endoscope.
[0018] It is desirable for the flexible tubular body to include a
resiliently deflectable portion.
[0019] It is desirable for the surgical instrument to include a
resiliently deflectable portion.
[0020] It is desirable for the flexible tubular body to include
grooves provided between each adjacent the circumferential
apertures.
[0021] It is desirable for a projection angle of the surgical
instruments from the flexible tubular body to be smaller than a
half angle of a field-of-view of the endoscope.
[0022] It is desirable for the endoscope to include an illumination
device which emits white light, and for the surgical instruments to
each include an illumination device which emits colored light.
[0023] Each illumination device of the surgical instruments can
continuously emit colored light.
[0024] Alternatively, each illumination device of the surgical
instruments can emit colored light intermittedly.
[0025] It is desirable for the endoscope to include an illumination
device, and for the surgical instruments to each include an
illumination device which emits light having light intensity
different from that of light emitted from the illumination device
of the endoscope.
[0026] It is desirable for the internal treatment system for a
patient to include an image displaying device for displaying an
image provided by the endoscope.
[0027] The present disclosure relates to subject matter contained
in Japanese Patent Application Nos.2003-281850 (filed on Jul. 29,
2003) and 2004-11954 (filed on Jan. 20, 2004) which are expressly
incorporated herein by reference in their entirety.
BRIEF DESCRIPTION OF THE DRAWINGS
[0028] FIG. 1 is a front view showing the configuration of an
internal treatment apparatus for a patient according to a first
embodiment of the present invention;
[0029] FIG. 2 is a perspective view showing the configuration of
the internal treatment apparatus for a patient with surgical
instruments and an endoscope being inserted therein in the first
embodiment;
[0030] FIG. 3 is a block diagram showing the relation between a
body, an endoscope, and surgical instruments, and body manipulating
device, endoscope manipulating device, surgical instrument
manipulating device, and image displaying device according to the
first embodiment of the present invention;
[0031] FIG. 4 is a view showing an example of a surgical procedure
being performed within a range of view of the endoscope according
to the first embodiment of the present invention;
[0032] FIG. 5 is a perspective view showing the configuration of a
modified example of the first embodiment of the present
invention;
[0033] FIG. 6 is a block diagram showing the relation between a
body, an endoscope, and surgical instruments, and manipulating
device and image displaying device according to the modified
example of the first embodiment of the present invention;
[0034] FIG. 7 is a front view showing the configuration of the body
of an internal treatment apparatus for a patient according to a
second embodiment of the present invention;
[0035] FIG. 8 is a sectional view taken along the line VIII-VIII of
FIG. 7;
[0036] FIG. 9 is a perspective view showing the configuration of
the internal treatment apparatus with surgical instruments and an
endoscope being inserted therein in the second embodiment;
[0037] FIG. 10 is a view showing an example of a surgical procedure
being performed within a range of view of the endoscope according
to the second embodiment of the present invention;
[0038] FIG. 11 is a front view showing the configuration of the
body of the internal treatment apparatus for a patient, provided
with five apertures according to the second embodiment of the
present invention;
[0039] FIG. 12 is a sectional view taken along the line XII-XII of
FIG. 11;
[0040] FIG. 13 is a perspective view showing the configuration of
the internal treatment apparatus for a patient of FIG. 11 with
surgical instruments and an endoscope being inserted therein;
[0041] FIG. 14 is a block diagram showing the relation between a
body, an endoscope, and surgical instruments, and body manipulating
device, endoscope manipulating device, surgical instrument
manipulating device, and image displaying device according to the
second embodiment of the present invention;
[0042] FIG. 15 shows a modification of the second embodiment, of
the present invention, and corresponds to FIG. 8;
[0043] FIG. 16 is a perspective view showing the configuration of
the internal treatment apparatus with surgical instruments and an
endoscope being inserted therein in the modified second embodiment
shown in FIG. 15;
[0044] FIG. 17 shows another modification of the second embodiment
of the present invention, corresponding to FIG. 8;
[0045] FIG. 18 is a perspective view showing the configuration of
the internal treatment apparatus with surgical instruments and an
endoscope being inserted therein in the modified second embodiment
shown in FIG. 17; and
[0046] FIG. 19 shows another modification of the second embodiment
of the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[First Embodiment]
[0047] A first embodiment of the present invention will be
described below in detail with reference to FIGS. 1 to 4. An
internal treatment apparatus 200 and an internal treatment system
300 according to this embodiment, which are intended to perform a
medical treatment on a site of lesion (target site) inside a
patient, include an apparatus body 10 having a center opening 20
and a circumferential opening portion 30. The internal treatment
system 300 also includes a body manipulating device 60, endoscope
manipulating device 70, and surgical instrument manipulating
devices 81 to 85. This embodiment to be described is provided with
the circumferential opening portion 30 having five apertures;
however, any number of apertures may be included in the
circumferential opening portion 30.
[0048] For example, the apparatus body 10, which is a flexible
tubular member to be introduced into a patient (subject), may have
an outer diameter of 5 cm. As shown in FIG. 2, the apparatus body
10 has a distal end portion 11 having a circular cross section with
its outer diameter reduced toward the distal end thereof, and a
resiliently deflectable portion 12 secured to a rear end face 11a
of the distal end portion 11. The apparatus body 10 is introduced
into a patient from the tip of the distal end portion 11 so as to
access deep inside the patient according to the location of a site
of lesion. The apparatus body 10 allows the body manipulating
device 60 connected to its proximal end portion to introduce or
withdraw the apparatus body 10 into or from the patient and adjust
the degree of deflection of the deflectable portion 12. For
example, the body manipulating device 60 includes a manual device
for the operator to manipulate manually, an automatic feed device,
and a winding device, which allow the body manipulating device 60
to make the apparatus body 10 operable from outside the
patient.
[0049] The apparatus body 10 is provided with the center opening
20, circular in cross section and extending through the center of
the cross section thereof, through which an endoscope is inserted
for a site of lesion (target site) to be observed. The apparatus
body 10 is also provided with the circumferential opening portion
30 of five apertures 31, 32, 33, 34, and 35, which are arranged at
equal angular intervals (angular intervals of 72 degrees) about a
center 20a of the center opening 20 and extend through the
apparatus body 10, so that surgical instruments can be fed
therethrough in order for surgical procedures to be performed on
the site of lesion. For example, with the apparatus body 10 having
an outer diameter of 5 cm, the apertures 31, 32, 33, 34, and 35
each can have an inner diameter of 1.2 cm. The distal end portion
11 and the center opening 20 may not necessarily be circular in
cross section. In this case, the five apertures 31, 32, 33, 34, and
35 may be preferably arranged to surround the center opening 20 at
equi-angular intervals between adjacent apertures. The center
opening 20 and the circumferential opening portion 30 may penetrate
through only the distal end portion 11 with the deflectable portion
12 made hollow.
[0050] A stereoscopic endoscope 21 is retractably inserted into and
extends through the center opening 20. The stereoscopic endoscope
21 has the following components fixedly inserted into a resiliently
deflectable cylindrical body 21a: two monitor optical systems 21b
and 21c for stereoscopically observing a site of lesion,
illumination optical systems 21d and 21e for illuminating the site
of lesion with light, an air feed line 21f for feeding air into the
patient, and a water feed line 21g for feeding water to the monitor
optical systems 21b and 21c to defog or clean the surface thereof.
The stereoscopic endoscope 21 is employed in this manner to observe
a site of lesion and the surrounding area thereof stereoscopically,
thereby making it possible to perform medical treatment precisely
and smoothly. Furthermore, the stereoscopic endoscope 21 is
connected at the proximal end portion thereof to the endoscope
manipulating device 70 for introducing and withdrawing the body
21a; adjusting the focus, field of view, and zooming of the monitor
optical systems 21b and 21c; adjusting the brightness, direction,
and angle of the illumination optical systems 21d and 21e; feeding
water to the monitor optical systems 21b and 21c to defog or clean
the surface thereof; and feeding air into the patient. The
endoscope manipulating device 70 allows the stereoscopic endoscope
21 to be operable from outside the patient. The monitor optical
systems 21b and 21c are connected at the proximal end portion of
the stereoscopic endoscope 21 to image displaying device 87 which
is capable of displaying stereoscopically the images of the site of
lesion and its surrounding provided thereby. It is also acceptable
to employ only a single monitor optical system depending on the
contents of medical treatment.
[0051] Flexible elongated surgical instruments 41, 42, 43, 44, and
45 are retractably inserted into and extend out of the apertures
31, 32, 33, 34, and 35, respectively. The surgical instruments 41,
42, 43, 44, and 45, which each have a resiliently deflectable
portion, are connected at their respective proximal end portions to
the surgical instrument manipulating devices 81, 82, 83, 84, and 85
to manipulate the surgical instruments. The surgical instruments
41, 42, 43, 44, and 45 may be inserted into any of the apertures
31, 32, 33, 34, and 35 depending on the order of medical treatment
steps or the shape of a site of lesion. Any surgical instruments
other than the surgical instruments 41, 42, 43, 44, and 45 can also
be inserted into the apertures 31, 32, 33, 34, and 35. For example,
assuming that the apertures 31, 32, 33, 34, and 35 each have an
inner diameter of 1.2 cm, each of the surgical instruments 41, 42,
43, 44, and 45 can have an outer diameter of 1 cm.
[0052] For example., the surgical instrument 41 has the following
components fixedly inserted into a resiliently deflectable
cylindrical body 41a to grasp the surrounding of the site of lesion
for excision with the surgical instrument 42 or 45: a grasper
forceps 41b capable of grasping an object; a monitor optical system
(monitor device) 41c for observing the vicinity of the tips of the
grasper forceps 41b; illumination optical systems (illumination
device) 41d and 41e for illuminating the vicinity of the tips of
the grasper forceps 41b with light; an air feed line 41f (air feed
device) for feeding air into the patient; and a water feed line 41g
(water feed device) for feeding water to the monitor optical system
41c to defog or clean the surface thereof. The surgical instrument
41 is connected at the proximal end portion thereof to the surgical
instrument manipulating device 81 for introducing, withdrawing, and
deflecting the body 41a; controlling the grasping operation of the
grasper forceps 41b; adjusting the focus, field of view, and
zooming of the monitor optical system 41c; adjusting the
brightness, direction, and angle of the illumination optical
systems 41d and 41e; and feeding water to the monitor optical
system 41c to defog or clean the surface thereof and feeding air
into the patient. The surgical instrument manipulating device 81
allows the surgical instrument 41 to be operable from outside the
patient. The monitor optical system 41c is connected at the
proximal end portion of the surgical instrument 41 to image
displaying device 91 which is capable of displaying the image of
the vicinity of the tips of the grasper forceps 41b provided by the
monitor optical system 41c. Two monitor optical systems may also be
employed to stereoscopically observe the vicinity of the tips of
the grasper forceps 41b. It is also possible to make infrared light
observations, fluorescent light observations, zoomed observations,
ultrasonic observations, confocal observations, or optical coherent
tomographic (OCT) observations.
[0053] For example, the surgical instrument 42 has the following
components fixedly inserted into a resiliently deflectable
cylindrical body 42a to sever the site of lesion whose surrounding
is grasped with the surgical instrument 41: a cutting forceps 42b
capable of severing an object; a monitor optical system (monitor
device) 42c for observing the vicinity of the tips of the cutting
forceps 42b; illumination optical systems (illumination device) 42d
and 42e for illuminating the vicinity of the tips of the cutting
forceps 42b with light; an air feed line 42f (air feed device) for
feeding air into the patient; and a water feed line 42g (water feed
device) for feeding water to the monitor optical system 42c to
defog or clean the surface thereof. The surgical instrument 42 is
connected at its proximal end portion to the surgical instrument
manipulating device 82 for introducing, withdrawing, and deflecting
the body 42a; controlling the severing operation of the cutting
forceps 42b; adjusting the focus, field of view, and zooming of the
monitor optical system 42c; adjusting the brightness, direction,
and angle of the illumination optical systems 42d and 42e; and
feeding water to the monitor optical system 42c to defog or clean
the surface thereof and feeding air into the patient. The surgical
instrument manipulating device 82 makes the surgical instrument 42
operable from outside the patient. The monitor optical system 42c
is connected at the proximal end portion of the surgical instrument
42 to image displaying device 92 which is capable of displaying the
image of the vicinity of the tips of the cutting forceps 42b
provided by the monitor optical system 42c. Two monitor optical
systems may also be employed to stereoscopically observe the
vicinity of the tips of the cutting forceps 42b. It is also
possible to make infrared light observations, fluorescent light
observations, zoomed observations, ultrasonic observations,
confocal observations, or optical coherent tomographic observations
(OCT).
[0054] The surgical instrument 43 has the following components
fixedly inserted into a resiliently deflectable cylindrical body
43a to feed water for cleaning the site of lesion and the
surrounding area thereof and apply suction to a liquid such as
blood or cleaning water at the site of lesion and the surrounding
area thereof. The components include a cleaning water feed/suction
tube 43b for feeding water to clean the site of lesion and the
surrounding area thereof and applying suction to a liquid such as
blood or cleaning water at the site of lesion and the surrounding
area thereof from outside the patient; a monitor optical system
(monitor device) 43c for observing the vicinity of the tip of the
cleaning water feed/suction tube 43b; illumination optical systems
(illumination device) 43d and 43e for illuminating the vicinity of
the tip of the cleaning water feed/suction tube 43b with light; and
an air feed line 43f (air feed device) for feeding air into the
patient and a water feed line 43g (water feed device) for feeding
water to the monitor optical system 43c to defog or clean the
surface thereof. The surgical instrument 43 is connected at its
proximal end portion to the surgical instrument manipulating device
83 for introducing, withdrawing, and deflecting the body 43a;
controlling the feeding of water and applications of suction by the
cleaning water feed/suction tube 43b; adjusting the focus, field of
view, and zooming of the monitor optical system 43c; adjusting the
brightness, direction, and angle of the illumination optical
systems 43d and 43e; and feeding water to the monitor optical
system 43c to defog or clean the surface thereof and feeding air
into the patient. The surgical instrument manipulating device 83
makes the surgical instrument 43 operable from outside the patient.
The monitor optical system 43c is connected at the proximal end
portion of the surgical instrument 43 to image displaying device 93
which is capable of displaying the image of the vicinity of the tip
of the cleaning water feed/suction tube 43b provided by the monitor
optical system 43c. Two monitor optical systems may also be
employed to stereoscopically observe the vicinity of the tip of the
cleaning water feed/suction tube 43b. It is also possible to make
infrared light observations, fluorescent light observations, zoomed
observations, ultrasonic observations, confocal observations, or
optical coherent tomographic (OCT) observations.
[0055] The surgical instrument 44 has the following components
fixedly inserted into a resiliently deflectable cylindrical body
44a to locally stop bleeding at a desired portion: an RF hemostatic
forceps 44b for applying a radio frequency to a desired portion and
thereby generating heat to stop bleeding; a monitor optical system
(monitor device) 44c for observing the vicinity of the tips of the
RF hemostatic forceps 44b; illumination optical systems
(illumination devices) 44d and 44e for illuminating the vicinity of
the tips of the RF hemostatic forceps 44b with light; an air feed
line 44f (air feed device) for feeding air into the patient; and a
water feed line 44g (water feed device) for feeding water to the
monitor optical system 44c to defog or clean the surface thereof.
The surgical instrument 44 is connected at the proximal end portion
thereof to the surgical instrument manipulating device 84 for
introducing, withdrawing, and deflecting the body 44a; controlling
the hemostatic operations provided by the RF hemostatic forceps
44b; adjusting the focus, field of view, and zooming of the monitor
optical system 44c; adjusting the brightness, direction, and angle
of the illumination optical systems 44d and 44e; and feeding water
to the monitor optical system 44c to defog or clean the surface
thereof and feeding air into the patient. The surgical instrument
manipulating device 84 allows the surgical instrument 44 to be
operable from outside the patient. The monitor optical system 44c
is connected at the proximal end portion of the surgical instrument
44 to an image displaying device 94 which is capable of displaying
the image of the vicinity of the tips of the RF hemostatic forceps
44b provided by the monitor optical system 44c. Two monitor optical
systems may also be employed to stereoscopically observe the
vicinity of the tips of the RF hemostatic forceps 44b. It is also
possible to make infrared light observations, fluorescent light
observations, zoomed observations, ultrasonic observations,
confocal observations, or optical coherent tomographic observations
(OCT).
[0056] The surgical instrument 45 has the following components
fixedly inserted into a resiliently deflectable cylindrical body
45a to incise a desired portion: an RF incision knife 45b for
pushing its RF-vibrating tip portion against a desired portion for
incision; a monitor optical system (monitor device) 45c for
observing the vicinity of the tip of the RF incision knife 45b;
illumination optical systems (illumination device) 45d and 45e for
illuminating the vicinity of the tip of the RF incision knife 45b
with light; an air feed line 45f (air feed device) for feeding air
into the patient; and a water feed line 45g (water feed device) for
feeding water to the monitor optical system 45c to defog or clean
the surface thereof. The surgical instrument 45 is connected at the
proximal end portion thereof to the surgical instrument
manipulating device 85 for introducing, withdrawing, and deflecting
the body 45a; controlling the incision operations provided by the
RF incision knife 45b; adjusting the focus, field of view, and
zooming of the monitor optical system 45c; adjusting the
brightness, direction, and angle of the illumination optical
systems 45d and 45e; and feeding water to the monitor optical
system 45c to defog or clean the surface thereof and feeding air
into the patient. The surgical instrument manipulating device 85
allows the surgical instrument 45 to be operable from outside the
patient. The monitor optical system 45c is connected at the
proximal end portion of the surgical instrument 45 to image
displaying device 95 which is capable of displaying the image of
the vicinity of the tip of the RF incision knife 45b provided by
the monitor optical system 45c. Two monitor optical systems may
also be employed to stereoscopically observe the vicinity of the
tip of RF incision knife 45b. It is also possible to make infrared
light observations, fluorescent light observations, zoomed
observations, ultrasonic observations, confocal observations, or
optical coherent tomographic observations (OCT).
[0057] The following is an explanation on a surgical procedure
performed on a site of lesion using the aforementioned internal
treatment apparatus 200 and the internal treatment system 300.
First, an adequate portion is incised to perform the surgical
procedure on a site of lesion in a patient. Even for a surgical
procedure that requires a plurality of surgical instruments, the
internal treatment apparatus 200 only requires an incised portion
just large enough to introduce therethrough the internal treatment
apparatus 200 into the patient (e.g., about 5 cm for the apparatus
body 10 having an outer diameter of 5 cm), thereby reducing the
burden on the patient.
[0058] Thereafter, the internal treatment apparatus 200 is
introduced into a patient 50 through the incised portion. Before
the insertion, the body manipulating device 60 is connected to the
apparatus body 10, the endoscope manipulating device 70 and the
image displaying device 87 are connected to the stereoscopic
endoscope 21, the surgical instrument manipulating devices 81
through 85 are connected to the surgical instruments 41 through 45,
respectively, and the image displaying devices 91 through 95 are
connected to the surgical instruments 41 through 45, respectively,
as shown in FIG. 3. The internal treatment apparatus 200 is
introduced into the patient and then stopped, so as to commence the
surgical procedure when a view range 22 of the stereoscopic
endoscope 21 allows the operator to view a lesion 55 and the
surrounding area thereof and each tip portion of the surgical
instruments 41, 42, 43, 44, and 45, as shown in FIG. 4.
[0059] The internal treatment apparatus 200 is designed such that
the surgical instruments 41 through 45 are arranged to surround the
stereoscopic endoscope 21, thereby allowing the surgical
instruments 41 through 45 to be placed along the entire
circumference of a view range provided by the stereoscopic
endoscope 21 during the surgical procedure. This allows the
operator to easily recognize the lesion 55 and the surgical
instruments 41 through 45, thereby facilitating the manipulation
thereof. Additionally, the surgical instruments can be replaced as
appropriate to facilitate a surgical operation. For example, as
shown in FIG. 4, two grasper forceps 41b can be used to elevate the
lesion 55 at the left and right sides thereof. The RF incision
knife 45b is then used to sever the lesion 55 at a base thereof,
and the RF hemostatic forceps 44b and the cleaning water
feed/suction tube 43b are then used to stop bleeding and feed
cleaning water from above as required. Furthermore, for a lesion 55
located deep inside the patient, the internal treatment apparatus
200 can be introduced deep into the patient to provide a view range
as shown in FIG. 4, thereby allowing the surgical procedure to be
performed smoothly with safety.
[0060] A modified example will be explained below. As shown in FIG.
5, the resiliently deflectable cylindrical bodies 41a, 42a, 43a,
44a, and 45a can be replaced with endoscopic insertion portions
141a, 142a, 143a, 144a, and 145a, respectively. In this case, the
grasper forceps 41b, the cutting forceps 42b, the cleaning water
feed/suction tube 43b, the RF hemostatic forceps 44b, and the RF
incision knife 45b are passed through forceps channels 141h, 142h,
143h, 144h, and 145h which are provided in the endoscopic insertion
portions 141a, 142a, 143a, 144a, and 145a, respectively. Likewise
with the surgical instruments 41, 42, 43, 44, and 45, the
endoscopic insertion portions 141a, 142.a, 143a, 144a, and 145a are
provided with a monitor optical system, an illumination optical
system, an air feed line, a water feed line, and a deflectable
portion. This configuration allows for utilizing an existing
endoscope, thereby reducing manufacturing costs.
[0061] As shown in FIG. 6, the body manipulating device 60, the
endoscope manipulating device 70, and the surgical instrument
manipulating devices 81 through 85 can be replaced with a
manipulating device 160 which allows the operator to collectively
or selectively manipulate the apparatus body 10, the stereoscopic
endoscope 21, and the surgical instruments 41 through 45. The image
displaying device 87 and the image displaying device 91 through 95
can be replaced with an image display device 190 which can
collectively or selectively display images from the monitor optical
systems 21b and 21c of the stereoscopic endoscope 21 and from the
monitor optical systems 41c, 42c, 43c, 44c, and 45c of the surgical
instruments 41 through 45. This configuration provides a
space-saving, compact system, allowing a less number of operators
to efficiently perform surgical procedures.
[Second Embodiment]
[0062] A second embodiment of the present invention will be
described below in detail with reference to FIGS. 7 through 14. An
internal treatment apparatus 400 and an internal treatment system
500 (FIG. 14) according to the second embodiment, which are
intended to perform a medical treatment on a site of lesion (target
site) inside a patient, include an apparatus body 10a having a
center opening 220 and a circumferential opening portion 130. The
internal treatment system 500 further includes a body manipulating
device 260, a endoscope manipulating device 170, and surgical
instrument manipulating devices 181 and 182.
[0063] The apparatus body 10a can be formed as a flexible tubular
member to be introduced into a patient (subject). As shown in FIG.
9, the apparatus body 10a includes a distal end portion 111 having
a circular cross section with the outer diameter thereof reduced
toward its distal end, and a resiliently deflectable portion 112
secured to a rear end face 111a of the distal end portion 111. The
apparatus body 10a is introduced into a patient from the tip of the
distal end portion 111 so as to reach deep inside the patient to
the location of a site of lesion. The apparatus body 10a allows the
body manipulating device 260 (FIG. 14) connected to the proximal
end portion thereof to introduce or withdraw the apparatus body 10a
into or from the patient and adjust the degree of deflection of the
deflectable portion 112. For example, the body manipulating device
260 includes a manual device for the operator for manual
manipulation, an automatic feed device, and a winding device, which
allows the body manipulating device 260 to make the apparatus body
10a operable from outside the patient.
[0064] The cylindrical apparatus body 10a is provided with the
circular center opening 220, which passes through the apparatus
body 10a from the center of one bottom face (distal end face) 111b
of the two bottom faces, the bottom face 111b facing the lesion 55,
toward the other bottom face (proximal end face, not shown). The
apparatus body 10a is further provided with the circumferential
opening portion 130 which passes through the apparatus body 10a
from a side face 112b of the deflectable portion 112 toward a
proximal end face 10c (FIG. 14) of the apparatus body 10a. A
stereoscopic endoscope 221 for observing a site of lesion (target
site) is inserted through the center opening 220 to protrude from
an outlet 220b to the lesion 55. The circumferential opening
portion 130 includes two circular apertures 131 and 132 disposed at
equi-angular intervals (at intervals of 180 degrees in this
embodiment) about a center 220a of the center opening 220. Surgical
instruments 242 and 241 for performing a surgical procedure on a
site of lesion are passed through the apertures 131 and 132 to
protrude outwardly from outlets 131a and 132a, respectively. The
distance between the outlet 131a and the distal end face 111b is
equal to that between the outlet 132a and the distal end face 111b.
The outlets 131a and 132a being preferably equal in inner diameter
would allow the surgical instruments 241 and 242 to be replaced
according to the contents and steps of surgical procedures. It is
also desirable to make the inner diameter of the outlets 131a and
132a greater than the outer diameter of the surgical instruments
241 and 242 to use the surgical instruments 241 and 242 at desired
angles.
[0065] The apparatus body 10a having the apertures 131 and 132 can
be formed according to an existing technique. For example, it is
possible to form the apparatus body 10a having the apertures 131
and 132 by molding a heat meltable resin in a mold having a
cylindrical portion the same in shape as the apertures 131 and 132
and then solidifying the resin by cooling. The apertures 131 and
132 formed in this manner would prevent the endoscope and two
surgical instruments from being entangled or interfering with each
other inside the apparatus body 10a, thereby eliminating the
difficulty of manipulating them. For example, the apparatus body
10a formed as described above may have an outer diameter of 5 cm
with the apertures 131 and 132 each having an inner diameter of 1.2
cm. On the other hand, the distal end portion 111 and the center
opening 220 may have not necessarily to be circular in cross
section.
[0066] As shown in FIG. 9, the stereoscopic endoscope 221 has the
following components fixedly inserted into a resiliently
deflectable cylindrical body 221a. The components include two
monitor optical systems 221b and 221c for stereoscopically
observing a site of lesion; illumination optical systems 221d and
221e for illuminating the site of lesion with light; an air feed
line 221f for feeding air into the patient; and a water feed line
221g for feeding water to the monitor optical systems 221b and 221c
to defog or clean the surface thereof. The stereoscopic endoscope
221 is employed in this manner to observe a site of lesion and the
surrounding area thereof stereoscopically, thereby making it
possible to perform medical treatment precisely and smoothly.
Furthermore, as shown in FIG. 14, the stereoscopic endoscope 221 is
connected at the proximal end portion thereof to the endoscope
manipulating device 170 for introducing and withdrawing the body
221a; adjusting the focus, field of view, and zooming of the
monitor optical systems 221b and 221; cadjusting the brightness,
direction, and angle of the illumination optical systems 221d and
221e; and feeding water to the monitor optical systems 221b and
221c to defog or clean the surface thereof and feeding air into the
patient. This allows the endoscope manipulating device 170 to make
the stereoscopic endoscope 221 operable from outside the patient.
The monitor optical systems 221b and 221c are connected at the
proximal end portion of the stereoscopic endoscope 221 to image
displaying device 187 which is capable of displaying
stereoscopically the images of the site of lesion and its
surrounding provided thereby. It is also possible to employ only a
single monitor optical system depending on the contents of medical
treatments.
[0067] For example, as shown in FIG. 9, the surgical instrument 241
has the following components fixedly inserted into a resiliently
deflectable cylindrical body 241a to sever the site of lesion whose
surrounding is grasped with the surgical instrument 242: a cutting
forceps 241b capable of severing an object; a monitor optical
system (monitor device) 241c for observing the vicinity of the tips
of the cutting forceps 241b; illumination optical systems
(illumination device) 241d and 241e for illuminating the vicinity
of the tips of the cutting forceps 241b with light; and an air feed
line 241f (air feed device) for feeding air into the patient and a
water feed line 241g (water feed device) for feeding water to the
monitor optical system 241c to defog or clean the surface thereof.
As shown in FIG. 14, the surgical instrument 241 is connected at
the proximal end portion thereof to the surgical instrument
manipulating device 181 for introducing, withdrawing, and
deflecting the body 241a; controlling the severing operation of the
cutting forceps 241b; adjusting the focus, field of view, and
zooming of the monitor optical system 241c; adjusting the
brightness, direction, and angle of the illumination optical
systems 241d and 241e; and feeding water to the monitor optical
system 241c to defog or clean the surface thereof and feeding air
into the patient. This allows the surgical instrument manipulating
device 181 to make the surgical instrument 241 operable from
outside the patient. The monitor optical system 241c is connected
at the proximal end portion of the surgical instrument 241 to an
image displaying device 191 which is capable of displaying the
image of the vicinity of the tips of the cutting forceps 241b
provided by the monitor optical system 241c. Two monitor optical
systems may also be employed to stereoscopically observe the
vicinity of the tips of the cutting forceps 241b. It is also
possible to make infrared light observations, fluorescent light
observations, zoomed observations, ultrasonic observations,
confocal observations, or optical coherent tomographic (OCT)
observations.
[0068] For example, as shown in FIG. 9, the surgical instrument 242
has the following components fixedly inserted into a resiliently
deflectable cylindrical body 242a to sever the site of lesion whose
surrounding is grasped with the surgical instrument 241: a cutting
forceps 242b capable of severing an object; a monitor optical
system (monitor device) 242c for observing the vicinity of the tips
of the cutting forceps 242b; illumination optical systems
(illumination device) 242d and 242e for illuminating the vicinity
of the tips of the cutting forceps 242b with light; and an air feed
line 242f (air feed device) for feeding air into the patient and a
water feed line 242g (water feed device) for feeding water to the
monitor optical system 242c to defog or clean the surface thereof.
As shown in FIG. 14, the surgical instrument 242 is connected at
its proximal end portion to the surgical instrument manipulating
device 182 for introducing, withdrawing, and deflecting the body
242a; controlling the severing operation of the cutting forceps
242b; adjusting the focus, field of view, and zooming of the
monitor optical system 242c; adjusting the brightness, direction,
and angle of the illumination optical systems 242d and 242e; and
feeding water to the monitor optical system 242c to defog or clean
the surface thereof and feeding air into the patient. This allows
the surgical instrument manipulating device 182 to make the
surgical instrument 242 operable from outside the patient. The
monitor optical system 242c is connected at the proximal end
portion of the surgical instrument 242 to an image displaying
device 192 which is capable of displaying the image of the vicinity
of the tips of the cutting forceps 242b provided by the monitor
optical system 242c. Two monitor optical systems may also be
employed to stereoscopically observe the vicinity of the tips of
the cutting forceps 242b. It is also possible to make infrared
light observations, fluorescent light observations, zoomed
observations, ultrasonic observations, confocal observations, or
optical coherent tomographic (OCT) observations.
[0069] The surgical instruments 241 and 242 may be inserted into
any of the apertures 131 and 132 depending on the order of medical
treatment steps or the shape of a site of lesion. Any surgical
instruments other than the surgical instruments 241 and 242 can
also be inserted into the apertures 131 and 132. For example,
assuming that the apertures 131 and 132 each have an inner diameter
of 1.2 cm, each of the surgical instruments 241 and 242 can have an
outer diameter of 1 cm.
[0070] In this manner, the stereoscopic endoscope 221 protrudes
from the distal end face 111b while the surgical instruments 241
and 242 are protruded from the side faces, thereby reducing the
risk of the surgical instruments 241 and 242 being tangled with
each other inside the patient 50. Accordingly, the stereoscopic
endoscope 221 and the surgical instruments 241 and 242 can be
easily placed at desired positions. Furthermore, as shown in FIG.
10, the surgical instruments 241 and 242 access the lesion 55 from
right and left sides within the view range provided by the
stereoscopic endoscope 221, thereby allowing the operator to view
an enlarged range without being obstructed by the surgical
instruments 241 and 242.
[0071] It is possible to employ any number of apertures in the
circumferential opening portion 130. For example, as shown in FIGS.
11 to 13, five apertures can be employed in the circumferential
opening portion 130. In this example, the circumferential opening
portion 130 includes five apertures 131, 132, 133, 134, and 135.
The apertures 131, 132, 313, 134, and 135 are disposed at
equi-angular intervals (angular intervals of 72 degrees) about a
center 220a of the center opening 220 to extend through the
apparatus body 10a to reach circular outlets 131a, 132a, 133a,
134a, and 135a provided on the side face 112b, respectively. The
outlets 131a, 132a, 133a, 134a, and 135a are disposed at the equal
distance from the distal end face 111b. The aforementioned flexible
elongated surgical instruments 241, 242, 243, 244, and 245 are
retractably inserted into and penetrate the apertures 131, 132,
133, 134, and 135, respectively.
[0072] As shown in FIG. 13, the surgical instrument 243 has the
following components fixedly inserted into a resiliently
deflectable cylindrical body 243a to feed water for cleaning the
site of lesion and its surrounding and apply suction to a liquid
such as blood or cleaning water at the site of lesion and the
surrounding area thereof. The components include a cleaning water
feed/suction tube 243b for feeding water to clean the site of
lesion and the surrounding area thereof and applying suction to a
liquid such as blood or cleaning water at the site of lesion and
its surrounding from outside the patient; a monitor optical system
(monitor device) 243c for observing the vicinity of the tip of the
cleaning water feed/suction tube 243b; illumination optical systems
(illumination device) 243d and 243e for illuminating the vicinity
of the tip of the cleaning water feed/suction tube 243b with light;
and an air feed line 243f (air feed device) for feeding air into
the patient and a water feed line 243g (water feed device) for
feeding water to the monitor optical system 243c to defog or clean
the surface thereof. The surgical instrument 243 is connected at
its proximal end portion to surgical instrument manipulating device
(not shown) for introducing, withdrawing, and deflecting the body
243a; controlling the feeding of water and applications of suction
by the cleaning water feed/suction tube 243b; adjusting the focus,
field of view, and zooming of the monitor optical system 243c;
adjusting the brightness, direction, and angle of the illumination
optical systems 243d and 243e; and feeding water to the monitor
optical system 243c to defog or clean the surface thereof and
feeding air into the patient. This surgical instrument manipulating
device allows the surgical instrument 243 to be operable from
outside the patient. The monitor optical system 243c is connected
at the proximal end portion of the surgical instrument 243 to image
displaying device (not shown) which is capable of displaying the
image of the vicinity of the tip of the cleaning water feed/suction
tube 243b provided by the monitor optical system 243c. Two monitor
optical systems may also be employed to stereoscopically observe
the vicinity of the tip of the cleaning water feed/suction tube
243b. It is also possible to make infrared light observations,
fluorescent light observations, zoomed observations, ultrasonic
observations, confocal observations, or optical coherent
tomographic(OCT) observations.
[0073] As shown in FIG. 13, the surgical instrument 244 has the
following components fixedly inserted into a resiliently
deflectable cylindrical body 244a to locally stop bleeding at a
desired portion. The components include an RF hemostatic forceps
244b for applying a radio frequency locally to a desired portion
and thereby generating heat to stop bleeding; a monitor optical
system (monitor device) 244c for observing the vicinity of the tips
of the RF hemostatic forceps 244b; illumination optical systems
(illumination device) 244d and 244e for illuminating the vicinity
of the tips of the RF hemostatic forceps 244b with light; and an
air feed line 244f (air feed device) for feeding air into the
patient and a water feed line 244g (water feed device) for feeding
water to the monitor optical system 244c to defog or clean the
surface thereof. The surgical instrument 244 is connected at its
proximal end portion to surgical instrument manipulating device
(not shown) for introducing, withdrawing, and deflecting the body
244a; controlling the hemostatic operations provided by the RF
hemostatic forceps 244b; adjusting the focus, field of view, and
zooming of the monitor optical system 244c; adjusting the
brightness, direction, and angle of the illumination optical
systems 244d and 244e; and feeding water to the monitor optical
system 244c to defog or clean the surface thereof and feeding air
into the patient. This surgical instrument manipulating device
allows the surgical instrument 244 to be operable from outside the
patient. The monitor optical system 244c is connected at the
proximal end portion of the surgical instrument 244 to image
displaying device (not shown) which is capable of displaying the
image of the vicinity of the tips of the RF hemostatic forceps 244b
provided by the monitor optical system 244c. Two monitor optical
systems may also be employed to stereoscopically observe the
vicinity of the tips of the RF hemostatic forceps 244b. It is also
possible to make infrared light observations, fluorescent light
observations, zoomed observations, ultrasonic observations,
confocal observations, or optical coherent tomographic (OCT)
observations.
[0074] As shown in FIG. 13, the surgical instrument 245 has the
following components fixedly inserted into a resiliently
deflectable cylindrical body 245a to incise a desired portion. The
components include an RF incision knife 245b for pushing its
RF-vibrating tip portion against a desired portion for incision; a
monitor optical system (monitor device) 245c for observing the
vicinity of the tip of the RF incision knife 245b; illumination
optical systems (illumination device) 245d and 245e for
illuminating the vicinity of the tip of the RF incision knife 245b
with light; and an air feed line 245f (air feed device) for feeding
air into the patient and a water feed line 245g (water feed device)
for feeding water to the monitor optical system 245c to defog or
clean the surface thereof. The surgical instrument 245 is connected
at its proximal end portion to surgical instrument manipulating
device (not shown) for introducing, withdrawing, and deflecting the
body 245a; controlling the incision operations provided by the RF
incision knife 245b; adjusting the focus, field of view, and
zooming of the monitor optical system 245c; adjusting the
brightness, direction, and angle of the illumination optical
systems 245d and 245e; and feeding water to the monitor optical
system 245c to defog or clean the surface thereof and feeding air
into the patient. This surgical instrument manipulating device
allows the surgical instrument 245 to be operable from outside the
patient. The monitor optical system 245c is connected at the
proximal end portion of the surgical instrument 245 to image
displaying device (not shown) which is capable of displaying the
image of the vicinity of the tip of the RF incision knife 245b
provided by the monitor optical system 245c. Two monitor optical
systems may also be employed to stereoscopically observe the
vicinity of the tip of the RF incision knife 245b. It is also
possible to make infrared light observations, fluorescent light
observations, zoomed observations, ultrasonic observations,
confocal observations, or optical coherent tomographic (OCT)
observations.
[0075] The surgical instruments 241, 242, 243, 244, and 245 being
preferably equal in outer diameter could be inserted into any
aperture according to the contents and steps of the surgical
procedure. It is also desirable to make the inner diameter of the
outlets 131a, 132a, 133a, 134a, and 135a greater than the outer
diameter of the surgical instruments 241, 242, 243, 244, and 245 to
use the surgical instruments 241, 242, 243, 244, and 245 at desired
angles.
[0076] The following is an explanation on a surgical procedure
performed on a site of lesion using the internal treatment
apparatus 400 and the internal treatment system 500, shown in FIGS.
7 through 9. First, an adequate portion is incised to perform a
surgical procedure on a site of lesion in a patient. Even for a
surgical procedure that requires a plurality of surgical
instruments, the internal treatment apparatus 400 would require an
incised portion just large enough to introduce therethrough the
internal treatment apparatus 400 into the patient (e.g., about 5 cm
for the apparatus body 10a having an outer diameter of 5 cm),
thereby reducing the burden on the patient.
[0077] Thereafter, as shown in FIG. 14, the internal treatment
apparatus 400 is introduced into a patient 50 through the incised
portion. Before the insertion, the body manipulating device 260,
the endoscope manipulating device 170, the surgical instrument
manipulating devices 181 and 182, and the image displaying device
187 and 191 have been already connected to the apparatus body 10a,
the stereoscopic endoscope 221, and the surgical instruments 241
and 242 in the internal treatment apparatus 400. When introduced
into the patient 50, the surgical instruments 241 and 242 are
preferably accommodated inside the apparatus body l0a without being
protruded from the outlets 131a and 132a by manipulating the
surgical instrument manipulating devices 181 and 182. This is to
prevent the surgical instruments 241 and 242 from being protruded
from the apparatus body 10a to hurt the patient 50 during the
introduction. The internal treatment apparatus 400 is introduced
into the patient and then stopped to start the surgical procedure
when a view range 22 of the stereoscopic endoscope 221 allows the
operator to view a lesion 55 and the surrounding area thereof and
each tip portion of the surgical instruments 241, 242, as shown in
FIG. 10.
[0078] The internal treatment apparatus 400 is designed such that
the surgical instruments 241 and 242 are arranged to surround the
stereoscopic endoscope 221, thereby allowing the surgical
instruments 241 and 242 to come into the view provided by the
stereoscopic endoscope 221 from its periphery during the surgical
procedure. This allows the operator to easily recognize the lesion
55 and the surgical instruments 241 and 242, thereby facilitating
the manipulation thereof. Furthermore, the stereoscopic endoscope
221 is protruded from the distal end face 111b while the surgical
instruments 241 and 242 are protruded from the side face 112b,
thereby reducing the risk of the surgical instruments 241 and 242
being interfered with each other. Accordingly, for a lesion 55
located deep inside the patient, the internal treatment apparatus
400 can be introduced deep into the patient, thereby performing the
surgical procedure smoothly and with safety. The following are
explanations of modifications of the second embodiment, according
to the present invention.
[0079] The illumination light which is emitted from the
illumination optical systems 221d and 221e can be white light, and
the illumination light which is emitted from each of the
illumination optical systems 241d, 241e, 242d, 242e, 243d, 243e,
244d, 244e, 245d and 245e can be colored light. According to this
arrangement, if the surgical instruments 241 through 245 are
directed toward the center axis 10b of the apparatus body 10a,
colored light appears within the field-of-view of the stereoscopic
endoscope 221, and the farther the surgical instruments 241 through
245 are moved away from the center axis 10b, the amount of colored
light which appears within the field-of-view of the stereoscopic
endoscope 221 decreases. If such a characteristic is utilized,
operation of the surgical instruments 241 through 245 is
facilitated because the bending direction of the surgical
instruments 241 through 245 can be visually confirmed. It is
desirable for the illumination light emitted from the illumination
optical systems 221d, 221e, 241d, 241e, 242d, 242e, 243d, 243e,
244d, 244e, 245d and 245e, to be changeable between white light and
colored light.
[0080] Furthermore, it is desirable for each colored light emitted
from the surgical instruments 241 through 245 to be set so as to
have a different wavelength from each other. Accordingly, the
bending direction of each of the surgical instruments 241 through
245 can be visually confirmed individually. The white light and
colored light can be continuous light or intermitting light, and if
a combination of continuous light and intermitting light is
applied, light emitted from the illumination optical systems 221d
and 221e and light emitted from the illumination optical systems
221d, 221e, 241d, 241e, 242d, 242e, 243d, 243e, 244d, 244e, 245d
and 245e can be easily distinguished visually. Furthermore, if the
wavelength of the colored light is altered in accordance with time,
by changing the colored illumination state within the field-of-view
of the stereoscopic endoscope 221 during an operation, an object
under observation can be easily confirmed visually in the case
where one illumination color is insufficient for observation
throughout the duration of an operation.
[0081] Furthermore, the intensity of light emitted from the
illumination optical systems 221d and 221e can be made to differ
from the intensity of light emitted from the illumination optical
systems 221d, 221e, 241d, 241e, 242d, 242e, 243d, 243e, 244d, 244e,
245d and 245e. Accordingly, since the light emitted from the
illumination optical systems 221d and 221e, and the light emitted
from the illumination optical systems 221d, 221e, 241d, 241e, 242d,
242e, 243d, 243e, 244d, 244e, 245d and 245e can be easily
distinguished, the bending directions of the surgical instruments
241 through 245 can be visually confirmed, facilitating the
operation thereof.
[0082] As shown in FIG. 15, instead of the two circular apertures
131 and 132, two circular apertures 231 and 232 are provided. Two
channels 231b and 232b of the two circular apertures 231 and 232
extend parallel to a center axis 10b of an apparatus body 110a, and
are the same as two channels 131b and 132b, of the two circular
apertures 131 and 132, which extend parallel to the center axis 10b
of the apparatus body 10a. Outlets 231a and 232a are provided
closer to than the bottom face (distal end face) 111b than the
outlets 131a and 132a. Accordingly, compared to the two circular
apertures 131 and 132, the angle by which surgical instruments 341
and 342 (see FIG. 16) project out of the two circular apertures 231
and 232 of the apparatus body 110a (i.e., the angle with respect to
the center axis 10b of the apparatus body 110a) is smaller.
[0083] FIG. 16 shows the internal treatment apparatus 600 with
surgical instruments 341 and 342 being inserted into apertures 231
and 232, respectively, in the modified second embodiment of FIG.
15. The angle by which the surgical instrument 341 projects out of
the apparatus body 110a from the outlet 231a (i.e., the angle
between the center axis 10b and the surgical instrument 341 when
extended in a straight line (center axis 341h)), and the angle by
which the surgical instrument 342 projects out of the apparatus
body 110a from the outlet 232a (i.e., the angle between the center
axis 10b and the surgical instrument 342 when extended in a
straight line (center axis 342h)), are represented as `B` in FIG.
16, and the total angle `2B` thereof is less than the field-of-view
2A of the stereoscopic endoscope 321. According to this
construction, the distal ends of the surgical instruments 341 and
342 can easily fit into the field-of-view of the stereoscopic
endoscope 321 even if the surgical instruments 341 and 342 are
projected outwards in a straight line, so that a safe and reliable
treatment operation can be carried out quickly and easily. Note
that so long as the projection angle of each of the surgical
instruments 341 and 342 is smaller than `A`, i.e., the half-angle
of the field-of-view of the stereoscopic endoscope 321, the angle
of each of the surgical instruments 341 and 342 can be set to a
desired angle. Furthermore, it is desirable for the distal end
portions of the surgical instruments 341 and 342 to be semi-hard
rather than flexible in order to maintain the projection angle
thereof.
[0084] As shown in FIG. 17, instead of the two circular apertures
131 and 132, two circular apertures 331 and 332 are provided. Two
channels 331b and 332b of the two circular apertures 331 and 332
extend parallel to a center axis 110b of an apparatus body 210a,
and are the same as two channels 131b and 132b, of the two circular
apertures 131 and 132, which extend parallel to the center axis 10b
of the apparatus body 10a. Outlets 331a and 332a are provided so as
to extend over the resiliently deflectable portion 112 and the
bottom face (distal end face) 111b. Accordingly, compared to the
two circular apertures 131 and 132, the angle by which surgical
instruments 441 and 442 (see FIG. 18) project out of the two
circular apertures 331 and 332 of the apparatus body 210a (i.e.,
the angle with respect to the center axis 110b of the apparatus
body 210a) is smaller.
[0085] FIG. 18 shows the internal treatment apparatus 700 with
surgical instruments 441 and 442 being inserted into apertures 331
and 332, respectively, in the modified second embodiment of FIG.
17. The angle by which the surgical instrument 441 projects out of
the apparatus body 210a from the outlet 331a (i.e., the angle
between the center axis 110b and the surgical instrument 441 when
extended in a straight line (center axis 441h)), and the angle by
which the surgical instrument 442 projects out of the apparatus
body 210a from the outlet 332a (i.e., the angle between the center
axis 110b and the surgical instrument 442 when extended in a
straight line (center axis 442h)), are represented as `C` in FIG.
18, and the total angle `2C` thereof is less than the field-of-view
2A of the stereoscopic endoscope 421. According to this
construction, the distal ends of the surgical instruments 441 and
442 can easily fit into the field-of-view of the stereoscopic
endoscope 421 even if the surgical instruments 441 and 442 are
projected outwards in a straight line, so that a safe and reliable
treatment operation can be carried out quickly and easily. Note
that so long as the projection angle of each of the surgical
instruments 441 and 442 is smaller than `A`, i.e., the half-angle
of the field-of-view of the stereoscopic endoscope 421, the angle
of each of the surgical instruments 441 and 442 can be set to a
desired angle. Furthermore, it is desirable for the distal end
portions of the surgical instruments 441 and 442 to be semi-hard
rather than flexible in order to maintain the projection angle
thereof.
[0086] As shown in FIG. 19, grooves 541 through 545 having the same
shape and concaved in a direction from the side face 212b to the
10b can be provided in each space between two adjacent outlets 431a
and 435a (outlets 434a and 435a are not shown in FIG. 19) provided
on the side face 212b at equi-angular intervals around the center
opening 320. According to this construction, since the amount of
surface area to which the distal end portion 211 and the
resiliently deflectable portion 212 touches internal tissue of the
patient 50 can be reduced, it becomes easier to insert the internal
treatment apparatus 800 into the patient 50, and hence reducing the
burden on both the patient and the operator (practitioner). The
grooves 541 through 545 can be of a desired shape so long as the
amount of surface area to which the distal end portion 211 and the
resiliently deflectable portion 212 touches internal tissue of the
patient 50 can be reduced.
[0087] Other configurations, operations, effects, and modified
examples such as those of the first embodiment can also be applied
to the second embodiment.
[0088] According to an aspect of the present invention, surgical
instruments can be placed at equal angular intervals around an
endoscope for observing a target site. This reduces the length of
an incised portion for surgical procedures performed on a site of
lesion inside a patient even when a plurality of surgical
instruments are introduced at the same time through the incised
portion. Additionally, for a surgical procedure performed on a site
of lesion located deep inside the patient, it is possible to ensure
an adequate view range without increasing the length of the incised
portion. Furthermore, the surgical instruments are placed so as to
surround the endoscope for observing the site of lesion, thereby
preventing the surgical instruments from interfering with each
other and obstructing the view, and allowing the operator to
perform the surgical procedure smoothly.
[0089] According to another aspect of the present invention, an
endoscope is protruded from a bottom face of the cylindrical body
while surgical instruments are protruded from the side face. This
configuration prevents the surgical instruments from obstructing
the view window of the endoscope and restricting the field of view,
thereby eliminating the difficulty of viewing the site of lesion
and the surrounding area thereof. Furthermore, a plurality of
surgical instruments could be introduced into the patient to access
the site of lesion from the periphery of the view range provided by
the endoscope. This reduces the risk of interference between the
surgical instruments or the surgical instruments and the endoscope,
thus allowing the surgical instruments and the endoscope to
positively access the site of lesion. This also allows the surgical
instruments and the endoscope accommodated inside the body to be
introduced into the patient, thereby reducing the length of an
incised portion even when a plurality of surgical instruments are
introduced at the same time through the incised portion.
[0090] Obvious changes may be made in the specific embodiments of
the present invention described herein, such modifications being
within the spirit and scope of the invention claimed. It is
indicated that all matter contained herein is illustrative and does
not limit the scope of the present invention.
INDUSTRIAL APPLICABILITY
[0091] According to the present invention, the internal treatment
apparatus is designed such that the surgical instruments are
arranged to surround the stereoscopic endoscope, thereby allowing
the surgical instruments to be placed along the entire
circumference of a view range provided by the stereoscopic
endoscope during the surgical procedure. This allows the operator
to easily recognize the lesion and the surgical instruments,
thereby facilitating the manipulation thereof. Additionally, the
surgical instruments can be replaced as appropriate to facilitate a
surgical operation. Furthermore, for a lesion located deep inside
the patient, the internal treatment apparatus can be introduced
deep into the patient to provide a view range, thereby allowing the
surgical procedure to be performed smoothly with safety.
* * * * *